Can a nurse delegate tasks to home care caregivers in Georgia?

In limited cases. Georgia's Board of Nursing rules do not let an RN assign tasks that need a license to unlicensed staff. Instead, Georgia's proxy caregiver law lets a person with a disability choose a trained unlicensed caregiver to do health maintenance tasks, including giving medications and insulin injections, through a licensed provider such as a private home care agency. The client must sign an informed consent, and a licensed professional must train and check off the caregiver. Without that, home care aides can only remind clients and help them take their own medicine.

What conditions apply?

• Georgia does not use RN delegation for this. Instead, a 'proxy caregiver' chosen by a person with a disability (or their legal representative) may perform health maintenance activities, which by law are not the practice of nursing
• Proxy caregiving can be used through DCH-licensed providers, including licensed private home care providers; Medicare-certified home health agencies, hospices, hospitals and nursing homes are excluded
• The client or legal representative signs a written informed consent listing the exact tasks and caregivers
• Tasks follow written orders of a physician, APRN or PA and a written plan of care
• The caregiver completes competency-based training and a skills checklist in front of a licensed healthcare professional (RN, APRN, PA, pharmacist or physician), with re-evaluation at least yearly
• Medication administration requires the DCH medication curriculum and a minimum TOFHLA health-literacy score of 75
• Proxy caregivers may not give IV medications or the first dose of any subcutaneous or intramuscular injection
• Without proxy caregiver arrangements, private home care personal care staff may only remind clients to take medicine and assist with self-administration

Is there an exception for self-directed care?

The proxy caregiver law is itself consumer-directed: the disabled individual or their legally authorized representative selects the caregiver, and residential facilities may let the client hire a proxy caregiver directly.

What is the difference between medication reminders and administration?

Reminding a client to take their medicine, or handing them a container they open themselves, is usually treated as assistance. Giving the medicine, such as placing pills in the mouth, giving an injection or crushing tablets, is administration and generally needs a license or nurse delegation. Check your state's rule and the client's care plan.

What should you confirm with the state?

The proxy caregiver route applies only to clients with a disability and requires the DCH training curriculum; confirm requirements with the Department of Community Health.